SPEECH DELAY

ByNorrifhan Akmal IsmailNur Atiqah Ab Rahman

OUTLINES

Definition Normal speech development Signs of speech delay History taking Causes of speech delay

DEFINITION

Child’s speech development is significantly below the standard for children of the same age.

Age Achievement

1-6 months Coos in response to voiceLaughs

6-9 months Babbling

10-11 months Imitate soundsSays mama, dada without meaning

12 months Says mama dada with meaningImitate 2-3 syllables words

16-18 months 10 wordsShows 2 parts of body

2 years >50 wordsTwo words phrases

3 years Talk constantly in 3-4 word sentences

4 years Ask questionsTell stories

5 years Fluent speechGood articulationKnows ABCNames 4 coloursTells time

SIGN OF SPEECH DELAY•Is

nt babbling or speaking in mock sentences at all.

1year•H

e hasn’t said one word

1.5 years

•Say only few words

•Communicate mostly through grunting and pointing

2 years

•Speaking in single syllables

•Didn’t have vocabulary of 50 words

2.5 years

•Speaks only simple two word phrase

•Strangers cant understand his pronunciation

3 years

HISTORY TAKING Developmental history Maternal illness in pregnancy Maternal use of alcohol Perinatal history Past medical history Use of medication Psychosocial history More than one language spoken to the

child Family history

EXAMINATION

Check ears Check for any dysmorphic features Distraction test Developmental assessment

AETIOLOGY Hearing loss Global developmental delay Anatomical disorder Oromotor dysfunction Autism Bilingualism Receptive aphasia Expressive language disorder

HEARING LOSS

Impairment in either one or both ears of any severity

Can be due to

› Sensorineural : caused by a lesion in the cochlea or auditory nerve.

› Conductive : abnormalities of the ear canal or middle ear.

SENSORINEURAL CONDUCTIVE

Genetic Otitis media with effusion

Antenatal and perinatal-Congenital infection-Preterm -Hypoxic-ischaemic encephalopathy-Hyperbilirubinemia(bilirubin can damage the vestibulocochlear nerve)

Eustachian tube dysfunction-Down syndrome-Cleft palate

Postnatal-Meningitis/encephalitis-Head injury-Drugs ; aminoglycosides, frusemide

Impacted wax

SENSORINEURAL CONDUCTIVE

Usually present at birth, irreversible

Usually due to middle ear disease such as otitis mediaMore common

Management - If severe, need amplification with hearing aids/ cochlear implants

Management-Conservative-Surgical repair-Amplification

• No response when called• Talk loudly• Watching TV at high volumes• Mispronouncing words

Symptoms

HEARING TESTAGE TYPE OF TEST COMMENTS

Newborn screening Automated Otoacoustic Emission (AOE) test

Determines cochlear function by creating echo response. Sound wave given via probe

Any age Brainstem Auditory Evoked Response (BAER)

Measures brainstem responses to sound and recorded as wave activity

7-9 months Infant Distraction Test (IDT)

Assess the ability to hear a sound and turn to locate it.

Infants Behavioural observation assessment (BOA) test

Identifies body reactions to sound

>2.5years Conditioned play audiometry

Earphones placed on child They need to perform the action each time they hear the sound

Older children Pure tone audiometry (PTA)

Patient presses a response button/raises hand when the test tone is heard

GLOBAL DEVELOPMENTAL DELAY

Delay in all skill fields (gross motor, vision and fine motor, hearing and speech, language and cognition, social and behaviour)

i.e Down syndrome

DOWN’S SYNDROME Trisomy 21

Can be due to› Meiotic non-disjunction› Translocation› Mosaicism

Hearing impairment from secretory otitis media

Narrow Eustachian tube infection block glue ear hearing loss speech delay

Thyroid dysfunction hypothyroidism abnormal growth of brain mental retardation speech delay